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It's still the economy, stupid.

The aphorism from Bill Clinton's first presidential campaign, conjured up by the inimitable James Carville, is as apt today as it was when Carville plastered it to the wall of the campaign war room in 1992. President Barack Obama and his aides ought to keep that in mind as they work to get health care reform back on track.

A summer of discontent has fed a conventional wisdom that voters have turned against radical changes to the health care system. Obama should be skeptical of that conclusion.

It's quite likely that the public's general crankiness is fueled by growing unemployment, continuing tight credit and unabated foreclosures. If the economy were in better shape - specifically, if unemployment were going down instead of up - it's likely voters would be more willing to trust Obama to make radical changes to the dysfunctional health care system.

Unhappily, there isn't much more that the president or Congress can do to right the economy. Despite a steady drumbeat of criticism from conservatives, most economists agree that the stimulus package Obama pushed through Congress in February helped to avert a much deeper recession. Now, about all the Obama administration can do is wait for job growth to resume next year.

Meanwhile, the nation needs health care reform. Neither the president nor a Democratic Congress can afford to waste the opportunity worrying about recalcitrant Republicans, next year's midterm elections or declining poll numbers.

Take those recent polls showing that the public has suddenly grown very concerned about ballooning deficits. Last month, Quinnipiac University released a poll in which respondents said - overwhelmingly - that they are more worried about the deficit than they are about fixing the health care system. If a health care overhaul would add to the deficit, then, 57 percent said, Congress should abandon the health care fix.

There are a couple of factors underlying those numbers. The first, of course, is that conservatives have spent the summer denouncing health care reform as burdensome, intrusive and costly - a government initiative that will bankrupt the country. (That's the rhetoric coming from the conservatives who have a shred of decency left; concern over costs has some basis in fact. The rest of the right has ginned up outrage over nonexistent "death panels" and other faux scandals.) With so many talking heads worrying over the deficit, average voters have begun to focus on it, too.

The other factor is household debt, which, for many voters, can seem to mirror national debt woes. Americans understand their own personal circumstances, which often include high mortgage interest payments, staggering credit card debt and shrinking savings. Their own personal budgets serve as a reminder of what can happen when an individual or a government takes on too much debt.

But what if those worries over the deficit are misplaced? As New York Times columnist Paul Krugman, a Nobel laureate in economics, has written, Americans grew alarmed over budget deficits in the mid 1930s, as the Great Depression began to recede. Subsequently, the Federal Reserve, Congress and President Franklin Roosevelt began to pull back from the policies that had sparked job growth and recovery. As historians of that period know only too well, that caused a second downturn.

Obama and congressional Democrats need to stiffen their spines and ignore the polls. As it happens, about 40 percent of the projected deficit can be explained by the recession. When job growth returns, tax receipts will increase.

Voters' anxiety about deficits will also decrease as the economy begins to produce jobs, which will go a long way toward getting rid of that nagging feeling that things are on the wrong track. Fixing the health care system will also help lessen voters' anxiety, since even those who have insurance know they can lose it with a pink slip or a troubling diagnosis.

Indeed, congressional Democrats ought to worry about facing voters next year without having passed substantial health care reform, since that's one of the reasons they were elected. The last item on Carville's famous list, tacked up on the wall of the campaign war room, was this: "Don't forget health care."

Cynthia Tucker can be reached at

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